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Online Analytical Statistical Information System
Georgia Division of Public Health Programs
Georgia Division of Public Health Publications
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District Director Contact Information
Women’s Right To Know
Georgia Public Health Lab Implements New Fee
Effective April 1, 2010 the Georgia Public Health Lab (GPHL) will charge $10 for each of the following tests: Blood Lead, Hepatitis C, Routine HIV, Syphilis Serology, and Well Water (total coliform). This is the first fee increase since the mid-1980's.
What does this mean for family physicians?
If you care for a Medicaid fee-for-service child, and perform the lab screening as recommended in the Health Check Manual, this new fee will essentially decrease your Health Check reimbursement by $10. The Health Check Manual does encourage the use of the state labs located in Albany, Decatur, and Waycross. However, you can use an outside lab if you are certain the results are reported to the state. Access the most recent version of the Health Check Manual at www.ghp.ga.gov and select "Provider Information" tab. The Health Check Manual is updated quarterly.
A full laboratory fee schedule is available at http://health.state.ga.us/programs/lab For any questions, call GPHL at (404) 327-7900.
The Role of Annual Urine Albumin Screening in Diabetes
By: Adrienne Mims, MD and William McClellan, MD
In response to the growing prevalence of both diabetes mellitus (DM) and diabetic nephropathy, the American Diabetes Association (ADA) releases annual updates to their guidelines (American Diabetes Assoc. 2010). The ADA and the National Kidney Foundation (NKF) recommend that annual screening be done in patients with DM, measuring serum creatinine and albuminuria levels.
The Georgia Medical Care Foundation (GMCF), the Medicare Quality Improvement Organization for the state, is working with primary care providers to improve the detection of chronic kidney disease (CKD) among diabetics as part of its Ninth Statement of Work with the Centers for Medicare & Medicaid Services (CMS). Even though there has been a statewide improvement in microalbumin screening among Medicare beneficiaries, there are a number of diabetics who are not receiving it.
Persistent albuminuria ranging from 30-299 mg/24 h, or microalbuminuria, is the earliest stage of diabetic neuropathy in type 1 DM, and often in type 2 DM. (American Diabetes Assoc. 2010) It is suggested for patients with type 1 diabetes, that screening begin after 5 years’ disease duration and for patients with type 2 diabetes, that it begin at the time of disease diagnosis. Despite these recommendations, diabetic nephropathy is under diagnosed in the DM population. (Middleton RJ, Foley RN, et al. 2006) and (Radbill B, Murphy B, and LeRouth D. 2008) Medicare claims show that only 30% of patients with DM received an annual urine albumin test in 2008. Recommended tests are urine albumin, microalbumin (quantitative or semi-quantitative) or assay of urine protein.
There are several reasons to perform an annual screening to detect new albuminuria and to periodically monitor the level of albuminuria even after diagnosis. First, these screenings help in early detection of diabetic nephropathy, which allows clinicians to better strategize the patient’s disease management, as well as time to educate patients about chronic kidney disease (CKD). (Radbill B, Murphy B, and LeRouth D. 2008) Use of an angiotensin-converting enzyme (ACE) inhibitor has been shown to decrease the level of microalbuminuria and the rate of progression of renal disease. (Zelmanovitz T, Gerchman F, et al. 2009)
Second, in most cases, proteinuria and decreased glomerular filtration rate (GFR) occur concomitantly. (Zelmanovitz T, Gerchman F, et al. 2009) Early detection allows for interventions which can help reduce proteinuria and increase GFR. This includes intensification of dietary sodium restriction to the JNC 7 recommended goal of 2.4 grams of sodium (Krikken, Laverman et al. 2009). The persistence or progression of microalbuminuria in a type 2 diabetic patient should increase the frequency of monitoring of GFR and early referral of patients who have high rates of change of either proteinuria or drop in GFR. Use of either an ACE inhibitor or an angiotensin II receptor blocker (ARB) has been shown to decrease GFR thru inhibition of the Renin-Angiotensin-Aldosterone System (RAAS). (Radbill B, Murphy B, and LeRouth D. 2008)
Third, diabetic patients with increased albumin excretion are at higher risk of having concurrent retinopathy and neuropathy, as they are expressions of microvascular damage. (Savage, Estacio et al. 1996) and (Schmieder RE, Martin S, et al. 2009) Hence an annual dilated eye exam, as well as an annual monofilament pressure exam of the feet are recommended as diagnostic surveillance for these complications. (American Diabetes Assoc. 2010)
Fourth, evidence of albuminuria indicates kidney damage and as such should serve as a trigger to avoid nephrotoxic drugs. Drug-induced nephrotoxicity is more common in patients with diabetes and those with pre-existing renal insufficiency. Non-steroidal anti-inflammatory drugs (NSAIDs), especially, can cause inflammatory changes in many parts of the kidney which can lead to fibrosis and scarring. (Naughton C. 2008)
Fifth, clinicians should remember that contrast media is the third leading cause of acute renal failure acquired in the hospital. (Berg KJ. 2000) Patients with albuminuria are at increased risk of acute kidney injury due to radiographic contrast exposure. Annual screenings allow measures to be used to prevent this exposure and therefore any related injury (Feldkamp and Kribben 2008).
Lastly, microalbuminuria is predictive for cardiovascular morbidity and mortality. (de Zeeuw D. 2007) Its presence should be a guide to the intensity of antihypertensive therapy, with the goal of a systolic blood pressure of less than 130 and diastolic blood pressure of less than 80 mm Hg. Steps beyond using a RAAS agent to attain these goals include the addition of a diuretic to the antihypertensive drug program.
In conclusion, the measurement and monitoring of albumin excretion rates and serum creatinine on an annual basis in primary care is an important aid to clinical decision making in the management of diabetes mellitus. Consider using a Diabetes flow sheet to ensure timely evidence based care for your patients - http://www.gmcf.org/diabetes/FlowSheetForDiabetesCare.pdf
American Diabetes Association. Standards of Medical Care in Diabetes – 2010. Diabetes Care. 2010;3(Suppl.1):S11-S61.
Berg KJ. Nephrotoxicity related to contrast media. Scand J Urol Nephrol. 2000;34(5):317-22.
De Zeeuw D. Albuminuria: a target for treatment of type 2 diabetic nephropathy. Semin Nephrol. 2007;27(2):172-81.
Feldkamp T, and Kribben A. Contrast media induced nephropathy: definition, incidence, outcome, pathophysiology, risk factors and prevention. Minerva Med. 2008;99(2): 177-96.
Goldschmid MG, Domin WS, et al. Diabetes in urban African-Americans. II. High prevalence of microalbuminuria and nephropathy in African-Americans with diabetes. Diabetes Care. 1995;18(7): 955-61.
Gross JL, De Azevedo MJ, et al.Diabetic Nephropathy: Diagnosis, Prevention, and Treatment. Diabetes Care. 2005;28(1):176-88.
Krikken JA, Laverman GD, et al. Benefits of dietary sodium restriction in the management of chronic kidney disease. Curr Opin Nephrol Hypertens. 2009;18(6):531-8.
Naughton CA. Drug-Induced Nephrotoxicity. Am Fam Physician. 2008;78(6):743-50.
Radbill B, Murphy B, and LeRouth D. Rationale and Strategies for Early Detection and Management of Diabetic Kidney Disease. Mayo Clin Proc. 2008;83(12):1373-81.
Savage S, Estacio RO, et al. Urinary albumin excretion as a predictor of diabetic retinopathy, neuropathy, and cardiovascular disease in NIDDM. Diabetes Care. 1996;19(11): 1243-8.
Schmieder RE, Martin S, et al. Angiotensin Blockade to Reduce Microvascular Damage in Diabetes Mellitus. Dtsch Arztebl Int. 2009;106(34-35):556-62.
Zelmanovitz T, Gerchman F, et al. Diabetic nephropathy. Diabetic & Metabolic Syndrome [serial online] 2009;1(1):10. Available at: http://www.dmsjournal.com/content/1/1/10
American Diabetes Association. Standards of Medical Care in Diabetes – 2010. Diabetes Care. 2010;3(Suppl.1):S4-9
Georgia Physicians Required to Report Abortions Performed
The Woman’s Right to Know Act (WRTK) requires physicians performing abortions to submit an annual reporting form to the Department of Community Health (DCH).
On March 15, 2010 DCH released a letter to physicians regarding reporting requirements under the WRTK Act. The letter is available on the GAFP website here.
The WRTK law requires that pregnant women seeking an abortion are offered the opportunity to view an ultrasound and hear the fetal heartbeat. The physician who performs abortions is also required to report the number of patients who were provided the opportunity, and of that number those who elected to view the sonogram and those who elected to hear the fetal heartbeat. Under this law, physicians performing abortions must submit the WRTK Annual Reporting form available at http://health.state.ga.us/wrtk/physicians.asp on or before February 28 of every calendar year, or be subject to a late fee of $500 and possible reporting to the Composite Board of Medical Examiners. The referenced statutes may be accessed at: http://www.legis.state.ga.us
You can also access the Annual Reporting Form on the GAFP website here
If you have questions about the reporting requirements, please contact the Maternal and Child Health Program, Perinatal/Women’s Health Unit at 404-657-3143 or by email at wrtkinfo@dhr.state.ga.us
Georgia STD Internet Partner Notification Pilot
The epidemiology of sexually transmitted diseases (STDs) is changing as the Internet continues to play a greater role in facilitating sexual encounters. To effectively reach Georgia citizens who have been exposed to STDs, federal, state, and local governments are implementing innovative ways to notify partners through the Internet. In an effort to reach sexual partners, the state STD office is piloting an Internet Partner Notification (IPN) process to notify partners of their exposure to individuals who have been diagnosed with a STD. This process will allow health districts to forward internet contact information to the STD Office for notification via the internet. Partners will be instructed to call the location to obtain additional information about their exposure and the importance of seeking medical attention.
Internet communication has been known to facilitate sexual encounters and is now playing an integral role in understanding the epidemiology of STDs. Because more patients are naming contacts met on the internet, it is imperative that a process be developed to notify these partners of their exposure so that they may be tested and treated. In the United States, health officials reported over 36,000 cases of syphilis in 2006, including 9,756 cases of primary and secondary (P&S) syphilis. In 2006, half of all P&S syphilis cases were reported from 20 counties and 2 cities; and most P&S syphilis cases occurred in persons 20 to 39 years of age. With this in mind, the IPN has been prioritized to reflect the syphilis epidemiologic trends in the state of Georgia. Because the number of infectious syphilis cases has increased approximately 9 percent each year since 2003, there is much optimism that this new process will further intervene in the spread of disease.
For more information, contact Rhonda Burton at rtburton@dhr.state.ga.us, or Cathi Durham at cdurham@gafp.org.
Preconception Care
Georgia in Top 10 for Infant Mortality Rate – What Family Physicians Can Do
Preconception Care – Health Promotion - Series
Continued
Preconception Care Series Continued – Risk Assessment
Preconception Care Series Continued – Intervention
Preconception Care – A Tool for Family Physicians
Preconception Care: The Central Role of Pregnancy
Planning and Contraception by Dr. Anne Lang Dunlop
Georgia in Top 10 for Infant Mortality Rate – What Family Physicians Can Do
Unfortunately, Georgia ranks among the top ten states in the US with the highest infant mortality rate. In Georgia, 70 percent of infant deaths can be attributed to low birth weight of less than 1,500 gm. By improving maternal health, 67 percent of excess feto-infant mortality could be eliminated.
Preconception Care outlines measures that must begin before conception to have maximum impact. These measures include appropriate nutrition and supplementation, as well as screening and treating of substance abuse, STD’s, and chronic conditions. The goal of preconception care is to identify, eliminate or reduce modifiable risks to a woman’s health or her pregnancy outcome, and to identify and educate women about non-modifiable risks. Over the next few months, the GAFP will publish a series of newsletter articles addressing this very real concern of infant mortality and ways a family physician can make a difference.
For more information
or to set up an in-office visit please contact Cathi Durham at 800-392-3841
or at cdurham@gafp.org.
Preconception Care – Health Promotion - Series Continued
Last month we announced that the GAFP Public Health Committee will be providing information regarding Preconception Care through a series of newsletter articles. Primary care physicians can significantly reduce the infant mortality rate in Georgia by providing specific health care measures to women before they become pregnant. There are three main components to preconception care: health promotion, risk assessment, and interventions.
Health promotion consists of health education individualized to a woman’s
or couple’s needs. Some of these considerations include folic acid supplementation;
rubella and varicella vaccination; and screening for syphilis, chlamydia, gonorrhea,
hepatitis B, and HIV.
It is recommended that low-risk women who are capable of becoming pregnant
receive folic acid supplementation of 400 micrograms per day. For those women
at high risk of delivering a baby with neural tube defect (previous infant
or family history, insulin dependent diabetes mellitus, or those taking carbamazepine
or valproic acid), the recommended folic acid supplementation is 4 milligrams
per day. It has been documented that there is a 71 percent risk reduction for
recurrent neural tube defect when the folic acid supplement is 4 milligrams
daily.
Preconception vaccination is an essential element for reducing infant mortality. Women planning to become pregnant should be screened for rubella seronegativity and provided with the vaccination if non-immune. Women who contract rubella during the first trimester have a one-in-four chance of having a baby born with features of congenital rubella syndrome, which includes heart defects, blindness, deafness, and developmental disabilities. Women of uncertain immunity should have a Rubella IgG titre with a booster dose – if not pregnant or planning to get pregnant within three months. Varicella vaccine should also be considered in women who have not had chicken pox. Hepatitis B vaccination should also be considered for women planning a future pregnancy. During pregnancy, the risk of neonatal transmission for acute hepatitis B ranges from 10 percent in the first trimester to 90 percent in the third trimester. Infants exposed to acute infection in utero are at increased risk for low birth weight and preterm delivery.
Infant mortality can further be reduced by screening for sexually transmitted infections (STI’s). Early screening and treatment for chlamydia and gonorrhea prevent adverse outcomes for women and infants. STI’s occurring during pregnancy may result in fetal death, or substantial physical and developmental disabilities including mental retardation and blindness. Untreated syphilis can result in neonatal syphilis, still birth, and other morbidities. Finally, preconception HIV screening of women allows for early counseling and treatment prior to and during pregnancy, reducing viral load and the risk of neonatal HIV transmission.
Health promotion is obviously a vital part of preconception care. Next month we will discuss the risk assessment component. You can learn more about preconception care and earn free CME by viewing Dr. Anne Lang Dunlop’s presentation, “Lowering Infant Mortality in Georgia: Strategies in Family Medicine,” is available at http://www.gafp.org/online_cme.asp.
For additional information contact Cathi Durham, Director of Outreach, (800) 392-3841 or cdurham@gafp.org.
Preconception Care Series Continued – Risk Assessment
GAFP is providing valuable information on Preconception Care through a series of newsletter articles. Primary care physicians can significantly reduce the infant mortality rate in Georgia by providing specific health care measures to women before they become pregnant. There are three main components to preconception care: health promotion, risk assessment, and interventions. This month we are looking at risk assessment.
In addition to educating woman who may become or are planning to become pregnant about vaccinations, vitamins, and screening for infections, family physicians should also concentrate on risk assessment. As recommended by Dr. Anne Lang Dunlop, renowned preconception care expert (and an active GAFP member), there are three main areas to assess – substance screening and treatment, chronic disease control and medication management, and nutritional disorders management.
It is more important than ever to address tobacco and alcohol use during the assessment phase. Tobacco use is the leading preventable cause of low birth weight babies. It is also associated with placental abruption, preterm delivery, placenta previa, and miscarriage. Along with tobacco cessation counseling, women (and men) who are planning a pregnancy should be offered adjunct therapy such as a nicotine patch or gum. Alcohol use is the leading preventable cause of mental retardation. Not only does it affect all stages of pregnancy, there is no threshold of alcohol use that has been identified as safe during pregnancy. Clinical trials have shown that screening and brief behavioral counseling interventions in a primary care setting has reduced alcohol misuse.
Chronic disease control and medication management is essential for all women, and especially so for those planning to become pregnant. Women with pre-existing diabetes can decrease the risk of congenital malformations by achieving euglycmeic control before conception and maintaining near euglycemic control (<1 percent above normal range) during organogenesis. Additionally, women with hypothyroidism should be tested for appropriateness of the level of thyroid hormone replacement. Often the dosage of thyroid replacement needs to be adjusted in early pregnancy for proper neurological development of the fetus. Also women who are planning to become pregnant and are using oral anticoagulants should be counseled that treatment may need to be changed to a non-teratogenic anti-coagulant. Finally, women using medication for seizure disorders may also need to alter their treatment to a less teratogenic treatment prior to conception. Although anticonvulsant medication has a teratogenic risk, seizures increase the risk of malformations in the fetus.
Furthermore, women who are overweight should be counseled about risks including neural tube defects, preterm delivery, diabetes, hypertension, and thromboembolic disease. Screening and intensive counseling with behavioral interventions have been shown in clinical trials to promote sustained weight loss for obese adults.
Risk assessment is as important as health promotion when considering preconception care. There are multiple measures family physicians can take that will result in a decrease of infant mortality in Georgia. As we continue this series on Preconception Care, next month we will discuss specific interventions family physicians can take that will make a real difference.
You can learn more about preconception care and earn free CME by viewing Dr. Anne Lang Dunlop’s presentation, “Lowering Infant Mortality in Georgia: Strategies in Family Medicine,” at http://www.gafp.org/online_cme.asp.
For additional information contact Cathi Durham, Director of Outreach, (800) 392-3841 or cdurham@gafp.org.
Preconception Care Series Continued – Intervention
Primary care physicians can significantly reduce the infant mortality rate in Georgia by providing specific health care measures to women before they become pregnant. There are three main components to preconception care: health promotion, risk assessment, and intervention. You can view last month’s article on risk assessment in the January enewsletter at www.gafp.org; this month we will look at the last component, interventions. Next month we will offer tools for integrating preconception care with primary health care.
Family physicians are uniquely positioned to influence outcomes since the patients they see include females of all ages. “Every woman, every time” adds an anticipatory element essential to preconception care. In addition to speaking with women that are planning a pregnancy, it is also imperative to counsel all women who are capable of becoming pregnant as almost half of pregnancies are unplanned.
Primary intervention covers educating these women regarding the need to plan their pregnancy with a health care provider, focusing on reproductive potential, future pregnancy, and the impact of pregnancy on maternal and infant outcomes. It is particularly important to intervene given the high rate of unintended pregnancies and the low rate of pregnancy planning with a provider: 49 percent of pregnancies are unintended, unwanted or mistimed (Henshaw, S.K. Family Planning Perspectives 1998).
One tried and true intervention method was discussed during the Infant Mortality Summit hosted by the Georgia Division of Public Health. Alfred W. Brann, Jr, MD, Professor of Pediatrics, Emory University School of Medicine reported that there is a change noted in a woman’s reproduction when she is requested to write out her goals for the next year. When asked to do this at the six week check of her infant, nearly every woman includes not getting pregnant as part of her goal. The act of actually writing this down has shown to be very effective in avoiding unintended pregnancies. Additionally, by counseling the woman, and her partner, on birth control methods, the effectiveness of preconception counseling is increased further.
For more information, contact Cathi Durham, GAFP Director of Outreach at cdurham@gafp.org or (800) 392-384.
Preconception Care – A Tool for Family Physicians
Family physicians can significantly reduce the infant mortality rate in Georgia by providing specific health care measures to women before they become pregnant. Over the past three months, the GAFP newsletter has featured articles on the three main components to preconception care: health promotion, risk assessment, and interventions. This month we will review tools available for integrating preconception care with primary health care.
The Georgia Academy of Family Physicians, in collaboration with the Georgia Division of Public Health, is excited to announce the release of a Preconception Toolkit developed by our very own, Dr. Anne Lang Dunlop.
The toolkit includes information on:
- Screening for reproductive intentions and risk of unintended pregnancy
- Assessing for medical, obstetrical, psychosocial, environmental, and genetic/familial risks
- Documenting proper CPT codes for reimbursement of preconception care services
A toolkit was mailed to you in March. For additional information contact Cathi Durham, GAFP Director of Outreach, at (800)392-3841 or by email at cdurham@gafp.org.
Preconception Care: The Central Role of Pregnancy Planning and Contraception
Dr. Anne Lang Dunlop, GAFP member and preconception care expert, submitted the following article as the final piece to wrap up the six month preconception care article series in the GAFP newsletter.
Unintended pregnancies, short interpregnancy intervals, and the presence of specific risk factors and risk behaviors (lack of folic acid supplementation, poor control of chronic conditions, use of alcohol, tobacco, and street drugs) are linked with adverse pregnancy outcomes, including preterm and low birth weight births, which are leading contributors to infant mortality. Conversely, the improvement in women’s preconception health and achievement of planned and well-spaced pregnancies are associated with improved pregnancy outcomes and reduction in infant mortality. In fact, the Institute of Medicine notes that among the best protections against adverse pregnancy outcomes are to support women to have planned, optimally-spaced pregnancies and to enter pregnancy in good health.
Approximately half of pregnancies in the United States are unintended, and anywhere from 18-30 percent of pregnancies (depending upon maternal race/ethnicity) follow a short (< 18 month) interpregnancy interval. Research conducted in metropolitan Atlanta reveals that approximately 25 percent of women of reproductive age seeking primary health care services could be classified as at risk for unintended pregnancy based upon their answers to a screening assessment of their sexual and contraceptive practices. To address this issue, the Select Panel on Preconception Care was convened in 2005 by CDC and consists of nationally recognized experts from a variety of disciplines including those from obstetrics, family medicine, pediatrics, public health, reproductive health, and chronic and infectious disease. This esteemed panel has identified the need for health care professionals to play a direct role in screening women for the risk of unintended pregnancy and sexually transmitted infection and in offering family planning, contraceptive counseling and methods, when appropriate, as part of women’s routine health care. The Select Panel for Preconception Care specifically recommends that routine health promotion activities for all women of reproductive age begin with an assessment of women’s reproductive plans, which includes screening women for their intentions to become or not become pregnant in the short and long term and their risk for conceiving a pregnancy (whether intended or not).
The link between the reduction in unintended pregnancy and the provision of contraceptive services, including education and counseling regarding the appropriate use of particular methods, to women who do not desire pregnancy is obvious. Approximately 52 percent of unintended pregnancies result from couples not using contraception, 43 percent from inconsistent or incorrect use of contraception, and only 5 percent from contraceptive failure.
Less well recognized, albeit similarly important, is the link between the provision of family planning and contraception services as part of the care of women who desire a future pregnancy. Such services are important as they enable women to plan for their families by spacing, timing, and limiting their pregnancies. By promoting healthy spacing between pregnancies, family planning services address an important risk factor for low birth weight and preterm birth and, ultimately, infant mortality. By delaying and timing pregnancy, family planning services are important for reducing adolescent and teen pregnancies and for helping women with chronic medical conditions time their pregnancies to occur when their chronic health condition is under optimal control.
There are several medical conditions, as well as medications for treating those conditions, that are associated with adverse pregnancy outcomes. Importantly, there is evidence that the impact of these medical conditions on pregnancy outcomes can be altered by preconception measures. Thus, avoiding, delaying, or achieving optimal timing of a pregnancy in relation to the medical condition or the utilization of a particular medication regimen is an important component of preconception care. For many of the same medical conditions for which preconception care and pregnancy timing are important, there are considerations and criteria related to the selection of appropriate contraceptive methods (e.g., diabetes, hypertension). It is important to note, however, that while a given contraceptive method may present risks to a woman’s health in the setting of a particular medical condition, the risks presented by a pregnancy or a poorly timed pregnancy may outweigh the risks of the contraceptive method.
Given the high rates of pregnancies that are unintended, poorly spaced, and end in preterm and low birth weight births in Georgia and the recommendations of the Select Panel on Preconception Care, the Georgia Division of Public Health has developed a reproductive plans assessment tool that identifies women who are planning to become pregnant within the next 12 months or at a later point, and those who are at risk of becoming pregnant (regardless of plans) because of lack of or inappropriate use of contraception. The reproductive plans assessment tool is designed to be completed in the health care setting by women of reproductive age at least annually. A similar tool, when utilized in a family planning clinic setting, has been shown to increase subsequent pregnancy planning and intentness.
The reproductive plans assessment tool is actually one component of the Preconception Care Toolkit developed by the Georgia Division of Public Health. Other items contained in the Toolkit include:
- Questionnaires for screening for medical, obstetrical, psychosocial, environmental, and genetic/familial risks to pregnancy outcomes;
- Brochures to aid in educating and counseling patients about preconception health, pregnancy planning and spacing, and particular conditions that present risks to pregnancy outcomes, including steps they can take now to improve their preconception risks.
- A checklist for tracking performance of recommended preconception screenings and interventions;
- A billing sheet of CPT codes for reimbursement of preconception care services.
To obtain a reproductive plans assessment tool for incorporation into your practice, or the complete Preconception Care Toolkit, contact Cathi Durham, GAFP Director of Outreach, at (800)392-3841 or by email at cdurham@gafp.org.
Syphilis: The Hidden Epidemic
Primary and secondary syphilis continues to be a serious health issue in Georgia. In 2007, Georgia ranked 3rd in the nation for primary and secondary syphilis and ranked 16th for congenital syphilis. Our primary and secondary syphilis case rates have steadily increased each year, from 4.6 per 100,000 in 2001 to 7.3 per 100,000 in 2007. During this period, the male to female case rate is notably higher among males. This disparity is due to an increase in cases among men who have sex with men (MSM). Primary and secondary syphilis remains concentrated in Atlanta’s Metropolitan Region that includes Fulton (30.5), DeKalb (19.6), Cobb (8.4), Gwinnett (6.1) and Clayton counties (13.6).
Syphilis, a systemic and sexually transmitted disease, is caused by a spirochete bacterium called T. pallidum. Patients who have syphilis might seek treatment for signs or symptoms of primary (i.e., ulcer or chancre at the infection site) or secondary syphilis (manifestations that include, but are not limited to, skin rash, mucocutaneous lesions, and lymphadenopathy). Latent infections (no signs or symptoms) are detected by serologic testing.
Syphilis during Pregnancy
All women should be screened serologically for syphilis during the first trimester of pregnancy. Communities and populations in which the prevalence of syphilis is high or for patients at high risk, serologic testing should be performed twice during the third trimester, at 28 to 32 weeks’ gestation and at delivery. Infants should not be discharged from the hospital unless the syphilis serologic status of the mother has been determined at least one time during pregnancy and preferably again at delivery. Any woman who delivers a stillborn infant after 20 weeks’ gestation should be tested for syphilis.
CDC recommended treatment for adults
Benzathine Penicillin G 2.4 million units IM is the preferred drug for treatment for all stages of syphilis, except for neurosyphilis where aqueous crystalline penicillin G or procaine penicillin with probenicid is recommended. Please refer to the CDC guidelines for treatment details and recommendations for penicillin allergic patients.
Management of Sex Partners
Persons exposed sexually to a patient who has syphilis in any stage should be evaluated clinically and serologically then treated with a recommended regimen:
- Persons who were exposed within 90 days preceding the diagnosis of primary, secondary, or early latent syphilis in a sex partner might be infected even if sero-negative; therefore, such person should be treated presumptively.
- Persons who were exposed greater than 90 days before diagnosis of primary, secondary, or early latent syphilis in a sex partner should be treated presumptively if serologic test results are not available immediately and the opportunity for follow up is uncertain.
- Long-term sex partners of patients who have latent syphilis should be evaluated clinically and serologically for syphilis on the basis of the evaluation findings.
Syphilis is a mandated notifiable disease. For more information on Georgia’s reporting laws, visit the Georgia Department of Community Health, Division of Public Health at http://health.state.ga.us. For additional information on syphilis diagnosis and treatment, visit the Centers for Disease Control and Prevention website at http://www.cdc.gov/std.
Medicaid Eligibility for Haitian Earthquake Parolees
A message from the Georgia Department of Community Health
Haitians granted humanitarian parole because of the earthquake are qualified aliens and are exempt from the 5-year waiting period to be considered for Medicaid. Eligible Haitian parolees may receive all medical services available under the State plan and that are otherwise available to other eligible Medicaid members.
Frequently Asked Questions and Answers:
1. Are there any other Haitian nationals arriving who do not have humanitarian parole status?
Yes. Children who are U.S. citizens or are being brought in as parolees may be accompanied by an adult who have been granted a B2 visitor visa.
2. Are people on B2 visitor visas eligible for Medicaid?
No. Individuals admitted on B2 visas are not considered qualified aliens, nor are they considered lawfully residing in the U.S. due to the nature of their admission. However, individuals admitted with B2 visas may seek to qualify for Medicaid under the Emergency Medical Assistance (EMA) criteria, where applicable.
3. What other factors must be considered in establishing Medicaid eligibility for individuals evacuated from Haiti for medical care?
In addition to providing documentation as a humanitarian parolee, all other Medicaid eligibility criteria must be met, including status as a child, pregnant woman, parent, a person over 65 years old or a disabled person.
4. What if a person is incapacitated and cannot apply for Medicaid?
A responsible party representing the individual, who may be physically or mentally unable to apply for Medicaid directly, may submit an application on the individual’s behalf. Applications are filed in the same manner as for any person requesting Medicaid, through the local county Department of Human Resources, Division of Family and Children Services (DFCS). To locate your county DFCS office, go to www.http://dfcs.dhr.georgia.gov/portal/site/DHR-DFCS/.
For additional information or questions, refer to the CMS website at https://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_alp.php?&p_pv=4.1122&p_prods=1,2,476,1122; or contact the Georgia Health Partnership (GHP) Provider Inquiry line at (800) 766-4456.
CMO Health Services Help Lines
Georgia’s Care Management Organizations (CMOs), WellCare, Amerigroup, and PeachState, have 24-Hour Nurse Help Lines to offer information to members on health care matters. Also available on their websites are provider manuals, which may be of assistance to your front office staff. For additional information on this service for you and your patients, please contact the CMO directly.
24 hour CMO
Nurse Health Services Contact information and Provider information:
PeachState Health Plan, Nursewise 800-704-1484, Option 7
PeachState Provider Manual, see page 8 for Provider Responsibilities:
Americgroup Nurse Help Line 800-600-4441
Amerigroup Provider Manual, see page 24 for CM/Disease Management information:
WellCare Health Advice Line 800-919-8807
Quick Reference Guide for the provider hotline, claims, utilization management and customer service:
Guide for Addressing Senior Drivers Now Available
The Georgia Older Drivers Task Force (ODTF) is offering the “Physicians’ Guide for Assessing and Counseling Older Drivers’” CD, which includes a practical and easily administered plan for assessing older drivers as well as the legal and ethical responsibilities of Georgia physicians with regard to the safety of older drivers.
The resource was designed for primary care physicians by a task force that was established as part of Gov. Sonny Perdue’s Strategic Highway Safety Plan to educate older drivers and physicians. The CD PowerPoint Presentation can be obtained by contacting Herb Karp, MD, at (678) 527-3428 or hkarp@gaqio.sdps.org.
Mandatory STD Reporting in Georgia
In 2008, a total of 45,291 positive test results were reported by Georgia physicians, laboratories, and health care providers. All Georgia physicians, laboratories, and health care providers are required by law to report patients with Syphilis (adult and congenital), chlamydia, gonorrhea, chancroid and lymphogranuloma venereum (LGV).
- Both lab-confirmed and clinical diagnoses are reportable within the following time intervals:
- Report immediately – syphilis
- Report within 7 days - chlamydia, gonorrhea, chancroid and LGV
- Reports should include:
- Patient demographics
- Laboratory information
- Symptom history
- Treatment information
- Physicians can report STD cases one of three way:
- Electronically through the State Electronic Notifiable Disease Surveillance System at http://sendss.state.ga.us (Preferred Method);
- By fax to the local District Health Office;
- By mail, in an envelope marked CONFIDENTIAL to the local District Health Office.
To locate the District Health Office in your area, visit the Division of Public Health website at: www.health.state.ga.us/pdfs/epi/notifiable/ND%20Reporting%20Form.pdf
Although laboratories also are required to report STDs, provider case reporting enables health departments to receive complete demographic, diagnostic, and treatment information on patients. Complete case reporting increases the timeliness of health department STD intervention and assists with rapid identification of STD outbreaks in the community. It also provides a better understanding of disease trends in Georgia.
Each local health district offers partner services to individuals who are infected with a STD, infected individuals partners, and other persons who are at increased risk for infection. These services prevent transmission of STDs and reduce suffering from complications. A critical function of partner services is partner notification, a process by which infected persons are interviewed to elicit information about their partners, who can then be confidentially notified of their possible exposure or potential risk. Other functions of partner services include prevention counseling and referral to other prevention and support services.
For the latest information from the Department of Community Health, Division of Public Health, visit www.health.state.ga.us. For additional information or assistance contact: Linda Allen-Johnson, EPI/STD Surveillance Unit, Department of Community Health, Division of Public Health at lallen-johnson@dhr.state.ga.us.
Whooping Cough Booster Shot Recommended for Adolescents and Adults
Survey Shows Most Adults Don’t Know that Whooping Cough Remains Widespread in the United States
ATLANTA, GA--(November 9, 2009) -Many people may think of whooping cough as a disease of the past – something eradicated generations ago. However, the number of cases reported by the Centers for Disease Control and Prevention (CDC) indicate that whooping cough is still very much a public health concern; health experts estimate that up to 600,000 cases occur each year in adults alone. In Georgia, whooping cough cases are on the rise. According to the Georgia Division of Public Health, the number of whooping cough cases in the state in the first half of this year is more than double that of the same time period last year.
To help protect against whooping cough, the CDC and the American Academy of Family Physicians (AAFP) recommend that most adolescents and adults get a single dose of the whooping cough vaccine, also called “Tdap” vaccine (tetanus, diphtheria, acellular pertussis). Tdap is a one-time booster shot that is recommended for most adolescents and adults, if not previously vaccinated. For adults, it is recommended to replace a single dose of Td vaccine (tetanus and diphtheria toxoids) if they received their last dose of Td more than 10 years earlier and they have not previously received Tdap.
“It’s important that adolescents and adults are vaccinated against whooping cough to help boost immunity from this contagious disease,” said Brian K. Nadolne, MD, Family Medicine Department at Northside Hospital, Nadolne Family Medicine and Preventive Care, Georgia. “Many adults and adolescents may not know that there is a one-time booster shot that offers protection against whooping cough.”
The AAFP, with help from the Georgia chapter, has launched “Vaccination Matters: Help Protect Families from Whooping Cough,” a public health initiative designed to help people understand the importance of whooping cough vaccination for adolescents and adults.
A recent national survey revealed that more than three-quarters of adults (76 percent) didn’t know or didn’t think that whooping cough remains widespread in the United States. Many adults (61 percent) are not even aware that there is a vaccine for whooping cough.
Whooping Cough Can Be Serious
Whooping cough, also known as pertussis, can have a significant impact on a person’s health if contracted. A highly
contagious respiratory disease, whooping cough can cause a persistent, hacking cough severe enough to cause vomiting
and even break ribs. The illness may last for up to three months or more, and may lead to pneumonia, hospitalization
and missed work or school days.
People with whooping cough may not be aware they have it and can spread it to others, including infants and children. Babies who have not received all of their shots for whooping cough are especially vulnerable to complications.
Vaccines Are Not Just For Babies and New Parents
Protection against whooping cough wears off approximately five to 10 years after completion of childhood vaccination,
leaving adolescents and adults susceptible to whooping cough. In the survey, 72 percent of adults were unsure or didn’t
know this was possible.
The survey found that most adults (73 percent) believed they were up-to-date on their vaccinations. The CDC estimates that only 2.1 percent of adults received a Tdap vaccine between 2005 and 2007. For adults, the Tdap vaccine is recommended to replace a single dose of Td vaccine (tetanus and diphtheria toxoids) if they received their last dose of Td more than 10 years earlier and they have not previously received Tdap.
Family physicians can offer expert information on whooping cough vaccination for adolescents and adults. The Georgia Academy of Family Physicians encourages adults to talk to their physician about whooping cough and the Tdap vaccine.
The “Vaccination Matters: Help Protect Families from Whooping Cough” program is made possible through funding and support from GlaxoSmithKline.
Visit www.FamilyDoctor.org/VaccinationMatters for more information.
Chlamydia Related Infertility
Georgia is ranked 6th in the nation for Chlamydia cases with 42,913 cases reported in 2007. Chlamydia infections, caused by the bacterium Chlamydia trachomatis, may have long-term, serious health consequences for both men and women. Symptoms can be mild or even absent which can lead to permanent damage before it is ever diagnosed.
In women, untreated Chlamydia may migrate into the reproductive tract and lead to Pelvic Inflammatory Disease (PID). PID is the leading preventable cause of infertility in the US. Also, women infected with Chlamydia are up to five times more likely to become infected with HIV, if exposed. In pregnant women, Chlamydia infection places the health of the fetus at risk for pre-term delivery and eye infections. Also, Chlamydia is the leading cause of early infant pneumonia. All pregnant women should be screened for Chlamydia. In men, untreated Chlamydia infections may lead to Epididymitis, resulting in pain, fever, and possibly decreased fertility.
To help prevent the serious consequences of Chlamydia, the CDC recommends screening annually for Chlamydia for all sexually active women age 25 years and older women with risk factors for Chlamydia (a new sex partner or multiple sex partners).
Physicians can report Chlamydia and all other STD cases one of three ways:
- Electronically through the State Electronic Notifiable Disease Surveillance System at http://sendss.state.ga.us
- Mail in an envelope marked CONFIDENTIAL to the local District Health Office
- Fax to the local District Health Office
To locate the District Health Office in your area and obtain a report form, visit the Division of Public Health website at www.health.state.ga.us/pdfs/epi/notifiable/ND%20Reporting%20Form.pdf For more information, visit http://cdc.gov/std/chlamydia/STDFact-Chlamydia.htm or contact Cathi Durham at cdurham@gafp.org
Newborn Screening Provider Education Reminder
Savannah Family Physician Opens Doors to Women’s Health Education
In June, GAFP member Dr. Julia Johnson of Savannah, hosted a Lunch and Learn in her office. Cathi Durham, GAFP Director of Outreach, accompanied Public Health coordinators from the Coastal District to present up-to-date information on the eligibility requirements and the referral process for Children 1st, Babies Can’t Wait, Newborn Screening, and Women, Infant and Children (WIC). The Lunch and Learn provided an opportunity for Dr. Johnson and her office staff to learn more about these valuable programs and to meet their district’s coordinators.
If you are interested GAFP staff coordinating a Lunch and Learn in your office, please contact Cathi Durham at 404-321-7445 or cdurham@gafp.org
2-day Advanced Disaster Life Support Training
The National Disaster Life Support Foundation is offering Advanced Disaster Life Support training. It is an intensive, 2-day course that allows students to demonstrate competencies in casualty decontamination, specified essential skills, and mass casualty incident information systems/technology applications.
Course Overview:
Day 2 of ADLS® is the "hands on" day of training. Four skills stations reinforce the previous day's learning. These skills stations are as follows:
- MASS Triage
- Personal Protective Equipment (PPE) and Decontamination
- Disaster Skills
- Human Patient Simulator
Course Credits: 15.5 AMA PRA Category 1 credits & trade
Pre-requisites: BDLS®
For more information visit: http://www.ndlsf.org/common/content.asp?PAGE=137
Together Rx Access® Program Expands Eligibility Income Levels
Prescription Savings Now Available to Even More Uninsured Georgians
The rate of unemployment in Georgia has increased in the past year from six percent to nine percent, resulting in the loss of health benefits for many residents.* As a result, family physicians are seeing an increasing number of uninsured patients who are finding it difficult to stay healthy and to manage chronic disease. To make ends meet, these individuals may be cutting back on filling needed prescription medicines.
Because they engage in personal conversations with uninsured patients on a daily basis, family physicians are uniquely positioned to help uninsured Georgians by connecting them to available health resources, such as prescription assistance programs.
Rx Help for the Uninsured
One free program, Together Rx Access, provides eligible individuals and families with immediate and meaningful savings on prescription products right at their neighborhood pharmacy. In response to the nation’s challenging economic times, the pharmaceutical companies that sponsor the Program recently expanded the eligibility income levels required for enrollment. Now, even more uninsured Georgians are eligible for a Together Rx Access Card.
The new income levels are:
- $45,000 for a single person
- $60,000 for a family of two
- $75,000 for a family of three
- $90,000 for a family of four
- $105,000 for a family of five
In addition to meeting the expanded income levels, individuals must be legal residents of the United States, and have no public or private prescription coverage, or qualify for Medicare, to be eligible for the Together Rx Access Card.
Together Rx Access FOR GEORGIA Card
In August 2008, the Governor Sonny Perdue and Together Rx Access announced the launch of the Together Rx Access FOR GEORGIA Card, the first state specific Together Rx Access Card. As part of this effort, the State uses existing resources to identify residents who may benefit from the Program. To date, nearly 73,000 Georgians are Together Rx Access FOR GEORGIA cardholders.
Quick and Easy Enrollment
Together Rx Access offers potential cardholders a simple enrollment process. And, no documentation is required.
- Visit TogetherRxAccess.com to instantly enroll online.
- Call the toll-free phone number 1-800-250-2839.
- Complete a short paper application and return it by mail.
A Together Rx Access quick start savings card is also available. Potential enrollees simply detach the Card from a brochure and call the toll-free number to find out if they are eligible, enroll and instantly activate their Card. Family physicians interested in receiving a supply of quick start savings cards, or other enrollment materials for distribution to eligible patients, can visit www.togetherrxaccessonline.com/order/. For more information, visit TogetherRxAccess.com or call 1-800-250-2839. *State Health Facts, www.statehealthfacts.org. Accessed 4/20/2009.
STD Treatment Guidelines
The Department of Human Resources has released its Treatment Guidelines Summary for Sexually Transmitted Diseases. The summary, found inserted in this newsletter, has the CDC recommendations for the treatment of adults and adolescents. These guidelines are intended as a source for clinical guidance; they are not a comprehensive list of all effective regimens. An additional resource for training and consultation in the area of STD clinical management and prevention is available by calling 404-463-0408.
For further information, visit DHR/STD Prevention website at http://health.state.ga.us/programs/std/index.asp
April 14, 2009
Letter to Physicians
3/5/09
Dear Physician:
In the past few months there have been 18 reported cases of pertussis among elementary school students in four schools in East Cobb County. These cases were diagnosed primarily by PCR. PCR has some advantages in that it is rapid and believed to be more sensitive than culture, but in most labs the clinical sensitivity and specificity of PCR is unknown.
From 2/19-2/24/09, the Centers for Disease Control and Prevention (CDC) in cooperation with the Georgia Division of Public Health, and Cobb and Douglas Public Health conducted voluntary pertussis testing of actively coughing students at the four elementary schools. The goal of this evaluation was to confirm if the etiology of the cough illnesses was pertussis and to identify the magnitude of the problem. We tested 108 persons with cough from all four schools. Pertussis culture, PCR, and/or serology were performed by the CDC Pertussis Laboratory as appropriate.
Laboratory results provided confirmation that pertussis has been circulating in Cobb County. Of the 108 persons tested, 22 had evidence of recent pertussis infection. A very limited number were determined to be infectious during the time the specimens were collected and are currently being treated and excluded from school. Of the 18 children who tested positive, 17 had documentation of receiving five Dtap vaccines.
Because clinicians represent the front line in pertussis control, we would like to offer the following reminders about pertussis diagnosis and treatment:
- Pertussis has been shown to be circulating in Cobb County. Pertussis in both previously vaccinated school age children and adults can have milder, non-classical presentations. The diagnosis of pertussis should be considered in any individual presenting with prolonged cough especially if accompanied by whoop, post-tussive vomiting, or paroxysmal cough, regardless of vaccination history. Pertussis culture is the most specific diagnostic test for pertussis. However, given documentation of pertussis circulation in Cobb County, positive pertussis PCR results should be regarded as definitive. Neither pertussis PCR nor cultures are believed to be sensitive tests after 14 days of cough. In patients with longer cough duration, pertussis serology may help with diagnosis; however, validated serology tests are currently not available commercially.
- Appropriate antibiotic therapy given in the first three weeks of cough may shorten cough duration and prevent transmission of pertussis. Persons with pertussis should refrain from close contact with others until they have completed 5 days of antibiotic therapy.
- Persons with pertussis who have not been treated are generally not considered infectious after 21 days. Antibiotic therapy is generally not considered useful after this time even though the cough may persist for months.
- Patients should be up-to-date on pertussis immunizations, including a Tdap booster after age 11 years.
- Please notify your local Health Department or call 866-PUB-HLTH if you identify a suspect or confirmed case.
- Recommendations for exclusion of suspect or confirmed cases from school or daycare and/or prophylaxis of contacts will be determined by the local Health Department.
For any questions please contact 404-657-2588 and ask for Dr. Julie Gabel, Dr. Jessica Tuttle, or Beth Ward. Thanks for your assistance.
Sincerely,
Susan Lance, D.V.M., Ph.D.
Director, Office of Protection and Safety, Georgia Division of Public Health
March 25, 2009
WIC Toolkits Available
Georgia’s WIC program is the nation's seventh largest Special Supplemental Nutrition Program for Women, Infants and Children. The Division of Public Health administers the program. Services are provided through our 18 health districts plus two contract agencies. These services include ntrition assessment and education, health screening, medical history, BMI, hemoglobin check, breast feeding support and education. One may apply by contacting either the State WIC Branch, or their local health department.
To learn specifically the data for your area, a county profile analysis is available at http://health.state.ga.us/wic-countyprofiles/index.aspx. The data includes WIC Program Performance measures during the 2007 fiscal year and can be used to determine the value of the WIC Program in each county.
The Georgia Academy of Family Physicians has a WIC Toolkit available for your convenience. You may access the kit via our website at www.gafp.org under the Public Health Resources tab or if you would like a hardcopy, feel free to contact the GAFP office at 404-321-7445, or email cdurham@gafp.org . If you are interested in-office training for you and your staff, please contact cdurham@gafp.org
Georgia Public Health Laboratory Cuts Hours
Effective Saturday November 8, 2008 the Georgia Public Health Laboratory (GPHL) discontinued operating on Saturdays, as a result of budgetary reductions. Fortunately, the Newborn Screening Unit of the GPHL will not be closed for more than 2 consecutive days. To accommodate extended holiday weekends, newborn screening testing will be performed on either Saturday or on the actual holiday (see schedule).
If you have any questions, please contact the Newborn Screening Unit of Georgia Public Health Laboratory at:
1749 Clairmont Road
Decatur, Georgia 30033
Telephone: 404-327-7950
Fax: 404-327-7919
2009 Holiday Newborn Screening Testing Schedule
Saturday, January 17, 2009 (MLK Jr. Birthday)
Saturday, April 25, 2009 (Confederate Memorial Day)
Saturday, May 23, 2009 (National Memorial Day)
Friday, July 3, 2009 (Independence Day)
Saturday, September 5, 2009 (Labor Day)
Saturday, October 10, 2009 (Columbus Day)
Saturday, November 28, 2009 (Thanksgiving/Lee’s Birthday)
Saturday, December 26, 2009 (Christmas/Washington's Birthday)
Babies Can’t Wait - What a Family Physician Should Know
Babies Can’t Wait is Georgia’s Part C Early Intervention Program under the Federal Individuals with Disabilities Education Improvement Act (IDEA). It is a comprehensive, coordinated, multidisciplinary, interagency system of early intervention support for infants and toddlers with disabilities from birth to age 3.
Children 0-36 months with developmental delay, developmental disabilities, and/or children with certain diagnosed disabling conditions with a high probability of resulting in delays are eligible. The complete list of the diagnoses that result in automatic eligibility for Babies Can’t Wait can be found at http://health.state.ga.us/pdfs/familyhealth/bcw/Category1ConditionsList.pdf
Anyone can refer a child to Babies Can’t Wait, including (but not limited to) parents, social workers, physicians, childcare providers, and teachers. Children 1st is the system point of entry for all Public Health programs for young children in Georgia. Referrals to Babies Can't Wait are made by completing the Children 1st Screening and Referral Form and mailing, faxing, or emailing the completed form to the Children 1st Coordinator in the district which serves the county in which the child resides. This can be found by accessing the complete list of Coordinators at http://health.state.ga.us/pdfs/familyhealth/csncoordinator.2004.pdf
The local Babies Can’t Wait office must acknowledge receipt, in writing, within three working days of receiving the referral. Families who are referred will be contacted by a representative of Babies Can't Wait within a few days following the referral. A date and time will be scheduled for an initial intake appointment. During that initial meeting, families share information about their priorities for their child and are provided information about Babies Can't Wait. Following completion of the intake appointment, the multidisciplinary evaluation and assessment is scheduled at a time that is convenient for the family. If the child is found eligible for services, an Individualized Family Service Plan (IFSP) will be developed with the family. Policy states that the child’s service coordinator, with written parental consent, will provide copies of evaluation reports and the IFSP to you within 15 working days of the evaluation or the IFSP meeting.
Once a part of Babies Can’t Wait, the child’s services will be provided by agencies and individuals from both private and public sectors. These professionals will represent various disciplines including, but not limited to audiologists, counselors, educators, nurses, nutritionists/dieticians, occupational therapists, physical therapists, speech-language pathologists, and/or psychologists. Professionals within all disciplines must meet the educational, licensure, and professional examination requirements established by the state of Georgia. Evaluation/assessment, service coordination, development of the IFSP and procedural safeguards are provided at no cost to families. The Children with Special Needs Financial Analysis Form is completed on all families prior to the development of the IFSP to determine the family’s assignment of cost participation/ability to pay for services outlined on the IFSP. In addition, with written parental consent, private insurance, Medicaid, CMOs and other insurance coverage also assist in covering the cost of services with Babies Can’t Wait being the pay or of last resort.
As the child's physician, you are encouraged to participate in all aspects of the child's and family's early intervention experience, beginning with referral and continuing through determination of eligibility, IFSP development, service delivery and transition out of BCW at age three. When a child reaches his or her third birthday, the family’s service coordinator will assist them in learning what resources may be available to them. These include services such as Georgia’s Department of Education Division for Exceptional Students and Bright from the Start’s Head Start. For more information contact 404-657-2726.
January 19, 2009
Woman's Right To Know - New 2007 Provisions
During the 2007 legislative session, House Bill 147 passed, which builds upon the requirements of House Bill 197, the "Woman's Right to Know" (WRTK) Act.
HB 147 requires that in all cases in which an ultrasound is performed prior to conducting an abortion, or a pre-abortion screen, the pregnant woman must be offered the opportunity to view the ultrasound and listen to the fetal heart rate. Although they are not required to view or to listen, this opportunity must be extended, and a completed consent placed in the chart signed by the woman indicating individually whether she declined or accepted to:
1. View the ultrasound
2. Listen to the heart beat
Medical providers in licensed abortion facilities who provide information to pregnant women under these laws must continue to submit the WRTK Annual Reporting form, as they did previously, by February 28, 2009.
The additional reporting requirements related to ultrasound can be accessed at http://health.state.ga.us/wrtk/
If you have questions, comments or suggestions regarding the updated requirements, please feel free to contact the Office of Birth Outcomes, Perinatal/ Women's Health Unit at (404) 657-3143 or by email at wrtkinfo@dhr.state.ga.us
December 5, 2008
Georgia Partnership For Caring Provides Medications For Your Uninsured Patients
Did you know that the Georgia Partnership for Caring pharmacy program provides a basic formulary of 100 medications that fight chronic diseases such as diabetes, epilepsy, glaucoma, hypertension, hyperlipidemia and hypothyroidism? There also are several antibiotics and antifungals on the formulary, as is Azmacort, a maintenance medication for asthma. The formulary of Novo Nordisk insulin includes Levemir.
Your uninsured patients with family income within 150 percent of the federal poverty level can qualify by submitting an application through the Right from the Start Medicaid outreach worker for your county or by faxing a completed application, with proof of income attached, to the partnership office at (678) 578-2930. When the application is approved, a letter will be sent to the applicant with a pharmacy card and instructions on how to use it to have prescriptions filled at a local pharmacy at no charge.
All Kroger pharmacies in Georgia and many independent pharmacies across the state dispense for the partnership program. The program’s toll-free information number, (800) 982-4723, is answered from 8:30 a.m. to 4:30 p.m., Monday through Friday, except for holidays.
For more information, call partnership Executive Director Tom Underwood at (678) 578-2926.
September 4, 2008